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Grand Rounds

Is Preeclampsia Associated with Greater Risk of Kidney Disease Later in Life?

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BACKGROUND AND PURPOSE:

  • Renal dysfunction is associated with preeclampsia, especially in the setting of severe preeclampsia
  • Kristensen et al. (BMJ, 2019) sought to determine if preeclampsia may be also be associated with later onset kidney disease

METHODS:

  • Nationwide register-based cohort study
  • Participants
    • ≥1 pregnancy lasting at least 20 weeks
  • Exposure: Preeclampsia
    • Validated against ACOG 2002 definitions
    • Diagnoses must be registered at least once in a window of 1 month prior to delivery or 7 days postpartum
    • Diagnoses only registered prior to 20 weeks not included
  • Primary outcome: Rates of kidney disease between women with and without a history of pre-eclampsia
    • Must have occurred at least 3 months postpartum
    • Diagnosis of moderate or severe: Hypertensive kidney disease | Glomerular disease | Chronic tubulointerstitial nephritis | Renal failure
  • Data Analysis
    • Hazard ratios (HR), estimated using Cox regression
    • Stratified by gestational age because preterm birth also associated with future kidney disease

RESULTS:

  • 1,072,330 women | 19,994,470 person years
    • Average follow up 18.6 years/woman
    • 14,816 cases of kidney disease
  • Women with a history or preeclampsia were more likely to develop any chronic renal conditions compared to those without a history of preeclampsia
    • Early preterm (<34 weeks) preeclampsia: HR 3.93 (95% CI, 2.90 to 5.33)
    • Late preterm preeclampsia (34-36 weeks): HR 2.81 (95% CI, 2.13 to 3.71)
    • Term preeclampsia (≥37 weeks): HR 2.27 (95% CI, 2.02 to 2.55)
  • Strong associations were found for
    • Chronic kidney disease
      • HR 2.90 for early preterm | HR 2.24 for late preterm | 2.27 for term
    • Hypertensive kidney disease
      • HR 4.19 for early preterm | HR 3.69 for late preterm | HR 3.06 for term
    • Glomerular/proteinuric disease
      • HR 5.34 for early preterm | HR 3.40 for late preterm | HR 2.14 for term
  • Adjustment for CVD and hypertension did reduce the association but only partially
  • Associations between preeclampsia and chronic kidney disease and glomerular/proteinuric disease were stronger within 5 years of latest pregnancy
    • ≤5 years since pregnancy
      • Chronic kidney disease: HR 6.11 (95% CI, 3.84 to 9.72)
      • Glomerular/proteinuric disease: HR 4.77 (95% CI, 3.88 to 5.86)
    • >5 years since pregnancy
      • Chronic kidney disease: HR 2.06 (95% CI, 1.69 to 2.50)
      • Glomerular/proteinuric disease: HR 1.50 (95% CI, 1.19 to 1.88)
  • Associations were strong for chronic renal disease, as opposed to acute

CONCLUSION:

  • Preeclampsia was strongly associated with later onset chronic renal disease, particularly at earlier gestational ages and within 5 years from delivery
  • The authors conclude that earlier detection of renal disease could help preserve more function
  • Future research would address appropriate follow-up and interventions to maximize renal function

Learn More – Primary Sources:

Pre-eclampsia and risk of later kidney disease: nationwide cohort study

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Related ObG Topics:

Diagnosing Preeclampsia – Key Definitions and ACOG Guidelines
ACOG Preeclampsia Guidelines: Antenatal Management and Timing of Delivery
ACOG Guidance: Emergency Treatment for Severe Hypertension in Pregnancy
Does Placental Growth Factor Lead to a Quicker Diagnosis in Women with Suspected Pre-Eclampsia?
Is Eclampsia in Pregnancy Linked with Greater Risk for Seizure Disorder?

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